Autistic Children Are More Responsive to Tactile Sensory Stimulus.

Objective
This research was an experimental study that was aimed to detect differences response of tactile sensory stimulus between normal children and children with sensory brain development disorders such as Autism Spectrum Disorder (ASD).


Materials & Methods
A total of 134 children, in two groups including 67 healthy children (control) and 67 children with autism were studied. Tactile sensory stimulus responses in children were tested directly using a Reflex Hammer. In addition, tactile sensory sensitivity was also assessed via questionnaire Short Sensory Profile (SSP) filled out by the child's parents. All response data were analyzed using Fisher's Exact Test; questionnaire data was analyzed with the Mann-Whitney U Test.


Results
Autistic children were more sensitive to palpation and pain than children who were not autistic. Furthermore, the value of SSP was also significantly higher (P<0.05) in autistic children, which means that they always responded to all categories in the SSP questionnaire than children who are not autistic.


Conclusion
Autistic children are more sensitive to tactile sensory stimulus and all categories of SSP than children who are not autistic.


Introduction
Sensory organs are peripheral components of the somatosensory system whose function is to record physical and chemical changes in the external and internal environment of the body and turn them into electrical impulses that are processed by the nervous system (1). One of the largest sensory Autistic Children Are More Responsive to Tactile Sensory Stimulus systems is located on the skin, which delivers information on stimuli such as touch, vibration, pressure, pain, and temperature. This sensory aspect reception pattern has occurred since the age of children to adult (2).
In children, this neurological system helps the process of categorizing and developing responses to information obtained from the environment.
Each child has a different ability to process and to respond to information or stimuli from the environment (3). Normally, children who receive stimulation on the skin or body surface process it in the brain and then generate appropriate responses to the sensation or stimulus received (4).
However, some children with sensory processing disorder find it difficult to interpret and to respond appropriately to the stimulus received (5).
Generally, children with autism syndrome have problems associated with neural development in the brain such that the processes of sensory integration in the brain are distracted (6). The Tactile Sensory system is a sensory system set up by tactile response and pain receptors in the skin (7); the Short Sensory Profile (SSP) is a method of measuring sensory system response using a questionnaire, usually used to determine the contribution of the sensory aspects of children in everyday life and can be used to explain differences in tactile sensitivity (8,9).
We aimed to show differences in sensory integration in children with sensory brain development disorder (Autism Spectrum Disorder), especially in tactile sensory sensitivity and SSP values.

Research Subjects
This study used random sampling to get the

Tactile Sensory Measurement
Tactile sensory sensitivity was measured using a Reflex Hammer due to it was the most popular tool in Indonesia and could provide reliable data.
The testing procedure was applied along with SSP questionnaires (Supp.data1). The Touch Assessment Test (Reflex Hammer) touches and scratches the skin of the arm of the blindfolded respondents for 1.5 seconds at a random location.
Then the respondents were asked to tell where on their arm they felt the stimulus touches. Reflex Hammers were used to view the tactile sensitivity to touch and pain response.

Statistical Analysis
The data obtained were tabulated and analyzed.

Autistic Children Are More Responsive to Tactile Sensory Stimulus
The data's sample characteristics, in general, were analyzed with descriptive statistics. The differences in tactile sensory response (tactile and pain response) between both groups were analyzed using Fisher's Exact Test, and in the SSP using the Mann-Whitney U Test. The entire analysis was using the statistical program SPSS for Windows version 17.0 (Chicago, IL, UA). to the touch and pain responses ( Table 2).

Discussion
Early detection for autism condition is necessary for further treatment. This study provided basic knowledge to understand autism condition. In individuals with good sensory integration, the brain has the ability to organize and process sensory input and use that input to respond appropriately to outside stimuli. However, some children with sensory processing disorder find it difficult to interpret and to respond appropriately than older children. Children with ASD were reported that they are over-responsiveness (11).
The results of that study indicated that ASD children were significantly more sensitive/overresponsive compared to controls. There was also a correlation between over-responsiveness with the tactile stimuli from parent reports and a lack of socializing (12). Besides, children with autism could be clearly seen to have sensory processing disorders. They tend to be more responsive to stimuli received compared to normal children.
The development of the somatosensory system in early infancy is hypothesized to be foundational for social and communication skills later in life (13). However, neurodevelopmental abnormalities in the brain may have a targeted influence on symptoms associated with ASD occurred in autism (14). Certain neurological development disorders in the brain cause many problems in processing tactile sensory input, causing sensations from the environment that are normally recorded and interpreted in the brain or central nervous system to be distracted: unable to filter inputs, often failing to process important information and prone to stress and anxiety (5,10). The neurobiological mechanisms against the incidence of abnormality